Abstract
BackgroundPathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). The major problems identified as impairing the quality of pathology reports are shortcomings of equipment, organization and insufficiently qualified personnel. In addition, in the context of breast cancer, immunohistochemistry (IHC) needs to be available for the evaluation of biomarkers. In the study presented, we aim to describe the current state of breast cancer pathology in order to highlight the unmet needs.MethodsWe obtained information on breast cancer pathology services within population-based cancer registries in SSA. A survey of 20 participating pathology centres was carried out. These centres represent large, rather well-equipped pathologies. The data obtained were related to the known population and breast cancer incidence of the registry areas.ResultsThe responding pathologists served populations of between 30,000 and 1.8 million and the centres surveyed dealt with 10–386 breast cancer cases per year. Time to fixation and formalin fixation time varied from overnight to more than 72 h. Only five centres processed core needle biopsies as a daily routine. Technical problems were common, with 14 centres reporting temporary power outages and 18 centres claiming to own faulty equipment with no access to technical support. Only half of the centres carried out IHC in their own laboratory. For three centres, IHC was only accessible outside of the country and one centre could not obtain any IHC results. A tumour board was established in 13 centres.ConclusionsWe conclude that breast cancer pathology services ensuring state-of-the-art therapy are only available in a small fraction of centres in SSA. To overcome these limitations, many of the centres require larger numbers of experienced pathologists and technical staff. Furthermore, equipment maintenance, standardization of processing guidelines and establishment of an IHC service are needed to comply with international standards of breast cancer pathology.
Highlights
Pathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA)
Depending on the pathology tier, laboratories should provide adequate equipment, skilled manpower and infrastructure for communication, documentation and storage to ensure that the capabilities for fine-needle aspiration cytology (FNAC), tissue biopsies/surgical excisions and tissue preparation, processing, haematoxylin-and-eosin staining and interpretation are guaranteed for each patient
A short description of the study and a questionnaire was sent to all members (24) of the African IHC Immunohistochemistry 1Most recent population (Cancer) Registry Network (AFCRN) in December 2016 by email
Summary
Pathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). While several studies have highlighted the need for early detection of breast cancer and downstaging to improve survival [5, 6], only a few studies have investigated the current capabilities of diagnostic and treatment services to provide a continuum of care. A recent study from Burkina Faso estimated a current annual unmet need of diagnostic services for 184,562 women with breast-related symptoms and pointed to the insufficient availability and quality of diagnostic services in SSA [7]. Pathology procedures in low- and middle-income countries should follow guidelines and quality assurance procedures [12] We performed this survey to assess the current status of essential components of the pre-analytic-, analytic-phase (e.g. timely specimen handling, cool chain, availability of buffered formalin, paraffin wax, freezer storage for antibodies and continuous supply of consumables and reagents) and post-analytic-phase (e.g. pathology reporting, storage of reports and formalin-fixed paraffin embeddedblocks).
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